Another report by Parkland Memorial Hospital’s safety monitors brings into sharper focus why so many patient-safety failures have occurred at the Dallas institution in recent years: Its internal watchdog unit for policing patient care fell down on the job.

One example the report cites “involved the death of a patient following the administration of a narcotic drug by a nurse.” Parkland’s internal investigators with the Quality of Care Department “did not uncover the fact that the nurse administered drugs without a physician order.”

That flawed inquiry is symptomatic of a broader collapse of controls in rooting out widespread care breakdowns, from the lack of a strong data-driven tracking system to protocols for conducting inquiries, the report says. Interviews with staff are rarely conducted, and basic questions aren’t asked such as, what does this mean? Or what really happened, and why?

The 26-page report, an evaluation of the hospital’s quality assessment and performance improvement program, has been kept secret, along with other documents, by Parkland since late February. We obtained it through a Freedom of Information Act request to the Centers for Medicare & Medicaid Services, Parkland’s chief regulator. I’ve uploaded the report on this post’s continuation.

Among the findings in the quality assessment evaluation:

* “Adverse events are too often viewed as isolated incidents, rather than symptoms of a systemic problem … often there is little investigation of adverse events other than (patient) chart review, if that is performed.”
* The quality department has more than 60 employees and “is more than adequately resourced with personnel.”
* Its investigations frequently “are not conducted or completed in a timely manner.” The delays “result in fact gathering errors” and “mean that unsafe practices may be continuing.”
* Department employees sometimes delete safety reports if more than one caregiver writes up the same event. “Vital information has been lost.”

Parkland Memorial Hospital continues to wage legal challenges to our requests for two sets of information we believe should be made public.

On one front, Parkland is asking the Texas Attorney General’s office to let it withhold surveillance camera footage that depicts a psych technician choking a patient unconscious. We have reported how the tech, Johnny Roberts, was fired last July about two weeks after the incident.

A Dallas County grand jury last month declined to indict Roberts, who has not responded to our interview requests, on criminal charges. The footage was part of the evidence package Parkland’s police department presented to Dallas County District Attorney’s office. Because grand jury proceedings are confidential by law, the details behind the decision are not known.

Months ago – before the case went to the jury – our attorney reached a provisional agreement with Parkland’s outside legal counsel to provide us the footage under the condition that the patient’s identity be protected through film editing. Parkland said the agreement also depended on whether the DA’s office agreed to release it, since it was in that office’s possession. The DA declined to do so.

Despite the grand jury’s decision, we are still pursuing the video recording to provide the public a more complete picture of what happened, especially in light of the series of abuse allegations inside the psychiatric emergency department in recent years. But Parkland is now arguing that the footage is exempted from disclosure because state law allows it to withhold information held by a law-enforcement agency that “did not result in conviction or deferred adjudication.”

On the second front, we are still seeking release of the Parkland “corrective action plan” authored by federally installed safety monitors, who recently found life-threatening dangers to patients throughout the hospital. Since early February, Parkland officials have declined to release the document, even though it outlines what the hospital needs to do to comply with government safety standards. Yesterday, they gave notice to the AG that they will challenge our right to access it, citing 58 various laws they say make it exempt.

We’ll continue to update you on developments.

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Publicly funded Parkland Memorial Hospital is giving general counsel Michael Silhol (right) a farewell payment of $332,280, according to records I obtained this afternoon with a Public Information Act request.

Silhol referred to a new state law that potentially privatizes some records related to public employees, but he didn’t give the Texas Government Code’s description of information that may be withheld about a public-hospital staffer. It is information that:

“could reasonably be expected to compromise the safety of the individual, such as information that describes or depicts the likeness of the individual, information stating the times that the individual arrives at or departs from work, a description of the individual’s automobile, or the location where the individual works or parks.”

I didn’t ask for anything like that — just names, job titles, pay, gender, ethnicity, start dates, employee ID numbers and work phone numbers. Other government bodies, including the Dallas Police Department and the Dallas school district, routinely release such information. We use it to check data, to make contacts, to ensure our reporting is accurate.

Silhol also told employees that Parkland wouldn’t release their direct-deposit banking information and Social Security numbers — stuff I’m not legally entitled to, stuff I did not and would not ask for. He also told them how to shield information about their home addresses, home phone numbers and family members — again, stuff I did not and would not ask for.

Here’s a look at public-interest stories in The Dallas Morning News and around the Web-o-sphere that gave me pause at breakfast:

1. Recession? What recession? Irving’s City Council voted last night to pay City Manager Tommy Gonzalez more than $390,000 a year. That makes him the highest paid city manager in the area and maybe the state, my dogged colleague Brandon Formby reports. Gonzalez made news last week with text messages saying the Dallas Cowboys organization “pushes things thru” City Hall and built a practice facility that “probably never was structurally sound enough.” He made those observations shortly after the facility collapsed; Brandon obtained the texts with an open-records request.